非洲埃博拉疫情期间心理健康服务的韧性。

Resilience of mental health services amidst Ebola disease outbreaks in Africa.

机构信息

University of Nebraska Medical Center, Omaha, NE, United States.

Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia.

出版信息

Front Public Health. 2024 May 30;12:1369306. doi: 10.3389/fpubh.2024.1369306. eCollection 2024.

DOI:10.3389/fpubh.2024.1369306

PMID:38873302

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11169587/

Abstract

INTRODUCTION: Health systems including mental health (MH) systems are resilient if they protect human life and produce better health outcomes for all during disease outbreaks or epidemics like Ebola disease and their aftermaths. We explored the resilience of MH services amidst Ebola disease outbreaks in Africa; specifically, to (i) describe the pre-, during-, and post-Ebola disease outbreak MH systems in African countries that have experienced Ebola disease outbreaks, (ii) determine the prevalence of three high burden MH disorders and how those prevalences interact with Ebola disease outbreaks, and, (iii) describe the resilience of MH systems in the context of these outbreaks. METHODS: This was a scoping review employing an adapted PRISMA statement. We conducted a five-step Boolean strategy with both free text and Medical Subject Headings (MeSH) to search 9 electronic databases and also searched WHO MINDbank and MH Atlas. RESULTS: The literature search yielded 1,230 publications. Twenty-five studies were included involving 13,449 participants. By 2023, 13 African nations had encountered a total of 35 Ebola outbreak events. None of these countries had a metric recorded in MH Atlas to assess the inclusion of MH in emergency plans. The three highest-burden outbreak-associated MH disorders under the MH and Psychosocial Support (MHPSS) framework were depression, post-traumatic stress disorder (PTSD), and anxiety with prevalence ranges of 1.4-7%, 2-90%, and 1.3-88%, respectively. Furthermore, our analysis revealed a concerning lack of resilience within the MH systems, as evidenced by the absence of pre-existing metrics to gauge MH preparedness in emergency plans. Additionally, none of the studies evaluated the resilience of MH services for individuals with pre-existing needs or examined potential post-outbreak degradation in core MH services. DISCUSSION: Our findings revealed an insufficiency of resilience, with no evaluation of services for individuals with pre-existing needs or post-outbreak degradation in core MH services. Strengthening MH resilience guided by evidence-based frameworks must be a priority to mitigate the long-term impacts of epidemics on mental well-being.

摘要

简介：如果卫生系统（包括心理健康系统）能够在埃博拉等疾病爆发或流行期间保护生命并为所有人提供更好的健康结果，那么它们就是有弹性的。我们探讨了非洲埃博拉疾病爆发期间心理健康服务的弹性；具体来说，（i）描述经历过埃博拉疾病爆发的非洲国家在埃博拉疾病爆发前、期间和之后的心理健康系统，（ii）确定三种高负担心理健康障碍的患病率，以及这些患病率如何与埃博拉疾病爆发相互作用，以及，（iii）描述这些爆发背景下心理健康系统的弹性。

方法：这是一项采用改编后的 PRISMA 声明的范围综述。我们采用五步布尔策略，结合自由文本和医学主题词（MeSH），在 9 个电子数据库中进行了搜索，还在世界卫生组织 MINDbank 和心理健康地图集（MH Atlas）中进行了搜索。

结果：文献检索产生了 1230 篇出版物。有 25 项研究纳入了 13449 名参与者。到 2023 年，13 个非洲国家共发生了 35 次埃博拉疫情爆发事件。这些国家都没有记录 MH Atlas 中的指标来评估 MH 纳入应急计划的情况。根据心理健康和心理社会支持（MHPSS）框架，三种最高负担的与疫情相关的心理健康障碍是抑郁症、创伤后应激障碍（PTSD）和焦虑症，患病率范围分别为 1.4-7%、2-90%和 1.3-88%。此外，我们的分析还揭示了心理健康系统内部存在令人担忧的弹性不足问题，这表现在应急计划中缺乏衡量心理健康准备情况的预先存在的指标。此外，没有研究评估针对有预先存在需求的个人的心理健康服务的弹性，也没有研究检查核心心理健康服务在疫情爆发后的潜在退化情况。

讨论：我们的研究结果表明，心理健康服务的弹性不足，没有评估针对有预先存在需求的个人的服务，也没有评估核心心理健康服务在疫情爆发后的退化情况。必须优先加强基于证据的框架指导的心理健康弹性，以减轻流行病对精神健康的长期影响。